Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis

  • Nature Microbiology 1, Article number: 15008 (2016)
  • doi:10.1038/nmicrobiol.2015.8
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Burkholderia pseudomallei, a highly pathogenic bacterium that causes melioidosis, is commonly found in soil in Southeast Asia and Northern Australia1,2. Melioidosis can be difficult to diagnose due to its diverse clinical manifestations and the inadequacy of conventional bacterial identification methods3. The bacterium is intrinsically resistant to a wide range of antimicrobials, and treatment with ineffective antimicrobials may result in case fatality rates (CFRs) exceeding 70%4,5. The importation of infected animals has, in the past, spread melioidosis to non-endemic areas6,7. The global distribution of B. pseudomallei and the burden of melioidosis, however, remain poorly understood. Here, we map documented human and animal cases and the presence of environmental B. pseudomallei and combine this in a formal modelling framework8,​9,​10 to estimate the global burden of melioidosis. We estimate there to be 165,000 (95% credible interval 68,000–412,000) human melioidosis cases per year worldwide, from which 89,000 (36,000–227,000) people die. Our estimates suggest that melioidosis is severely underreported in the 45 countries in which it is known to be endemic and that melioidosis is probably endemic in a further 34 countries that have never reported the disease. The large numbers of estimated cases and fatalities emphasize that the disease warrants renewed attention from public health officials and policy makers.

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The authors thank P. Wannapinij for technical support and N. J. White and K. Schaecher for comments on the final draft. The authors also thank M. Devine for proofreading. This work was funded by the Wellcome Trust (grant no. 101103). S.I.H. is funded by a Senior Research Fellowship from the Wellcome Trust (grant no. 095066) and grants from the Bill & Melinda Gates Foundation (nos. OPP1119467, OPP1106023 and OPP1093011). S.I.H. acknowledges funding support from the RAPIDD programme of the Science & Technology Directorate, Department of Homeland Security, and the Fogarty International Center, National Institutes of Health.

Author information


  1. Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK

    • Direk Limmathurotsakul
    • , Nick Golding
    • , David M. Pigott
    • , Catherine L. Moyes
    •  & Simon I. Hay
  2. Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand

    • Direk Limmathurotsakul
    • , Nicholas P. J. Day
    •  & Sharon J. Peacock
  3. Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand

    • Direk Limmathurotsakul
  4. Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao PDR

    • David A. B. Dance
  5. Centre for Tropical Medicine and Global Health, University of Oxford, Old Road Campus, Oxford OX3 7FZ, UK

    • David A. B. Dance
    •  & Nicholas P. J. Day
  6. Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3PS, UK

    • Jane P. Messina
  7. Universidade de Fortaleza, Fortaleza 60811-905, Brazil

    • Dionne B. Rolim
  8. Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva 27, Switzerland

    • Eric Bertherat
  9. Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK

    • Sharon J. Peacock
  10. London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK

    • Sharon J. Peacock
  11. Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington 98121, USA

    • Simon I. Hay
  12. Fogarty International Center, National Institutes of Health, Bethesda, Maryland 20892-2220, USA

    • Simon I. Hay


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D.L., D.D., E.B., N.P.J.D., S.J.P. and S.I.H. conceived the research. D.L. and S.I.H. drafted the manuscript. D.L. and D.D. reviewed all the occurrence data. D.L. and N.G. carried out the modelling and analysis with advice from S.I.H. D.L., N.G., J.M. and D.P. created the maps and figures. All authors discussed the results and contributed to the revision of the final manuscript.

Competing interests

The authors declare no competing financial interests.

Corresponding author

Correspondence to Direk Limmathurotsakul.

Supplementary information

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  1. 1.

    Supplementary Information

    Supplementary Methods, References, Table 1 and Figures 1–9.